What to do when SSRI's Don't Help Enough?

[tailspin]

I'm reposting something I posted yesterday in the Medication Forum in the hope that someone will respond to it here. Perhaps I really am the only person here who has not had much success with anti-depressant medication. I realize this is mainly an Anxiety Forum and not a Depression Forum, and this post is mainly about treatment resistant depression, but I'm re-posting this anyway just on the offchance. Thanks!

Hi there,

I have ongoing depression and anxiety issues and my depression has flared up really badly again over the past few weeks.

I have been dealing with depression and anxiety on and off throughout most of my life, though, thankfully, there have been long periods where I've been much better.

I'm now 49 years old and I probably started taking anti-depressant medication about 15 years ago. Over the years I have been on (in this order): Prozac, Paxil, Celexa, Effexor, Zoloft and now Lexapro. And I've given each drug a fair crack of the whip, remaining on it for months, if not years, and experimenting with different dosages (the only exception being Paxil which literally turned me into a zombie and I actually preferred being depressed and anxious to feeling like that). All the meds I've tried have helped a bit. Mainly they have helped with my panic attacks. But at the end of the day, they don't help enough.

My depression has been really awful lately. I realize that medication is only one part of the equation and I know I need to work on other things, but for the purposes of this post I just want to focus on the medication piece.

I'm especially interested to hear from other people who have tried several different medications without much success and what happened next. Did you simply find other ways to cope? Or did you continue trying different medications and eventually find one that worked? Or did you just accept the limitations of medication and settle with the little help that it does give?

Since I've tried most of the SSRI's and SNRI's already, I'm wondering whether to take a step back in time and go with an older tricyclic? Has anyone had any success with these? Or perhaps switch to another different class of medication? Though this would in all likelihood be very difficult for me to do since my anxiety would undoubtedly kick up a hell of a fuss about trying something completely new. At least I know that I tolerate the SSRI's pretty well.

Sadly, it is a fact that anti-depressant medication doesn't help everyone. I really want to remain hopeful that I may yet find something that does help, but it's getting harder. I realize that medication is usually a trial and error process, but I'm already on drug #6 and it's been 15 years or so.

Thanks for any feedback from anyone in a similar situation.

[acetone]

Tricyclics and MAOIs are an option. Many people swear by Phenelzine/Nardil(MAOI). Tricyclics also cause more side effects than SSRIs. There are dietary restrictions with MAOI. I have experience with one tricylic (Amitriptyline). It was hard being on this drug.

[jessed03]

Tailspin, hi... Fancy seeing you here, outside the word game ;) It feels like when I was at school and I met my teacher in the supermarket. My worlds feeling a little mixed up right now!

That's quite a few drugs really - 6! Most people stop at around 2. You can't say you've not given them all a fair crack, for sure!

There really are quite a few out there now, as acetone mentioned. Sadly, some aren't always without challenges.

Heres the way I look at mental health -

An analogy...

Go to the supermarket and buy two tins of sweetcorn. Take them home. Put one in the cupboard, and leave one out.

Pick up the tin that you left out........ and throw it against the wall, really hard.....for a few times, at least.

After its been thrown against the wall, pour all the sweetcorn out into a cup, and get your toolbox out.

Use any tool in there to try and fix and restore the container. Do your best to make it look new again. Get the dents out, try to re-form the little grooves, try and get the shape of the tin right.

Once done, pour the sweetcorn back in, reseal the lid, and get the other one out of the cupboard.

Place them down on a table together. Compare the two.

As you can imagine; No matter how hard you tried to fix the dented tin with your tools, or how long you worked on it, it never looks as natural or feels quite like it did when it was new, before it had been damaged.

We're all that 'tin of sweetcorn'. We all got thrown against the wall in our lives. The big question really; is how many times did we get hit, and how bad was the damage?

Some people walk around with small dents, and they tackle them early, and with a little patience and nurturing, they can work on it so that its barely even noticeable at all.

Others are less fortunate, and have been thrown at walls for one reason or another for an extended period of time.

These are the hard cases, as the damage runs deep, and it often takes multiple complex tools, and a lot of work, just to get into a position whereby the whole thing isn't just a write-off.

How badly have you been thrown in your life, and for how long?

Of course that's a very personal question you only have to answer yourself, but if the answer is you've had it tough in life, in whatever way, it may explain why the kinks in your life don't seem to correct themselves despite much hard work.

Another explanation for them not correcting themselves, is the tools you're using aren't good enough. You said you plan to work on some stuff, and you're very intelligent, so I know you'll take care of that, so for this threads sake, let's say the tools in this case are the meds; the antidepressants.

And this would make sense. I know you've said a few times your med doesn't seem to take you to the next level.

I think meds only work for something like 55% of people. CBT works for I think 68% (roughly)... So people who do both have around a 75%ish chance of seeing big, big improvements, and, 75% is a big number, but it doesn't include everyone. There are always going to be those who plateau, or can't make the breakthrough, often, through no fault of their own.

I guess I've found, simply from talking to so many people, that there are 2 ways people go about healthily addressing their 'dents';

To completely make peace with them - This is your classic acceptance therapy. Accepting there are faults and problems that are likely to never be completely resolved. Accepting bad patches and periods, and limitations, as extreme as they may be, and making peace with limited access to previous dreams. Accepting that this is just a product of many, many things outside of your control.

This often involves CBT elements too, such as removing perfectionist, and self critical thinking styles, and becoming ready (often through tiredness) to just submit to the waves of emotion and momentum that carry you through life.

This part means to find happiness in much smaller and less grandiose places, and often to remove ones self from expectation.

This is good, we all need to do it on some level, but it always felt fake when I tried it. I always, always felt I was lying to myself. I only recommend this for those who after a long time, and lots of work, are too tired to keep fighting, or the problem is too severe. Then -- a what will be will be attitude -- can bring you a lot of previously un-found solace.

The second way, and the best way, is of course;

Use better tools & Get help from better workmen- We're often tempted to fix everything with either a hammer or a screwdriver. We don't go too far outside a few select tools, as often they are hard to find, or hard to use.

Sometimes, also, some people can do far better jobs than we can, or our small circle can, only, we don't go and seek the help due to our doubtful states, or we don't have the funds/access to such help.

Chances are, tying this back into your question, you do have some faulty neurotransmitters that haven't been successfully hit yet, by your drug. It is believed different mechanisms of the drugs hit various types of transmitter in your brain. A very good psych will often be able to pinpoint what aspects of the brain are ineffective, and treat them with a relevant med or prescribe a combo of two meds, just to hit the transmitters they believe aren't doing their job.

Now this means two things; getting different meds, of course, and getting a very good psych. I went through several different types, and ended up on an atypical med for a few years, which helped a lot. Thankfully I could quit it pretty soon, and I did feel genuine long lasting changes after taking it. This after the usual SSRIs and the other ones they throw at you hadn't worked or made things worse. Maybe your issue isn't simply low serotonin, but another mechanical problem in the brain, that will benefit from a different type of med entirely, with the intention of stimulating different receptors which may or may not be a part of the problem.

Another example of getting better tools, includes getting better expertise. When learning meditation, my results were quite slow. Eventually I got frustrated, and travelled a long way to a temple, to get some advice, and it really did change my results dramatically for the better. There may be things you are trying to work on, or learn, which may be going slower, or may be less effective than you'd like at this point. Don't be afraid at all to take it up a notch, and seek expert help, to try and accomplish various goals on a more expert level.

CBT was another thing for me. I had a great, friendly therapist, who worked very hard on my issues, and whom I trusted. Only, after being discharged, I still had a fair few niggling problems, but didn't know why. I didn't have the knowledge of the practice, or a varied and competent understanding of my mind, simply as he hadn't given them to me, to know what was wrong. I didn't have the money at the time to pay top dollar for a new therapist, so sought knowledge through some great books. I noticed many thought patterns, many interpretations of life, many beliefs, many unmet desires, were still at large in my mind. I still had a narcissistic form of personality, which fuelled my frustration and anxiety. I set to work on fixing, or encouraging new pattern growths, and again saw favourable changes.

Another tool that was ineffective for me was my health efficiency tool. I'd had the standard blood tests when getting diagnosed with anxiety, but they always leave a lot out. I went to a holistic clinic, where they checked all my vitamin and nutrient levels, all my levels of omegas, and amino acids. They checked my adrenal health, my hormonal and thyroid health, my gut health, my organ health, my heavy metal count, my cardiovascular health (not all at once lol) etc... And I begun to find things there that weren't really as good as they could have been. Stress really depletes a tonne of things, or makes others work a little ineffectively. My breath holding time was just 13 seconds, so I bought a Frolov device, and received teaching from a Buteyko specialist in improving my cardiovascular health (as it really is the epitome of good health and mental calmness) and my relaxed, non strained breath hold time reached 24 seconds. I'm still working in this now. The ideal is 40-60.

I also found my adrenals were tired. I bought the book Adenal fatigue: a 21st century problem, and realised a lot of my tension, tiredness and depression was coming from this source, as stress and not so great sleeping had really taxed them.

I underwent a gut health program, simply because 80% of serotonin is traced to there. That's a huge number. I avoided coffee, sugar, fruit, dairy, yeast and excess carbs, for 3 months, took regular enzymes, omega 3, vitamin C, zinc and acidophilus. It helped more than just my mental health, and studies are coming out more and more regularly stating the advantages of doing such a thing.

These are a few examples personable to me. Perhaps you have some you can think of, techniques you use which maybe aren't as effective as they could be, coping mechanisms that are rusty and need refreshing. Perhaps not though. It isn't always the case. I know this post was about meds - I just thought while we're chatting I'd say don't just limit things to getting expert help in the med situation, if there are other things you want to improve, by all means seek the absolute best tools for the job if you can, whether that be advice, expertise, or simply just experimenting more so than others, in order to find the things that work the best for you. It's ok not to settle for just ok. :)

I hope you find some relief soon. Drs usually say try 2/3 types of the same antidepressant before moving class. You've tried 5. If you feel it's not good enough, and you've done all you can do with the dose, it really may well be time to think alternatives!

[alankay]

Some augment ssri's with buspar or wellbutrin but newer TCA sub types(Tetracyclic) like remeron or Asendin are there as well as the older ones like Doxepine, trazodone, clomimiprimine, etc. Alankay

[tailspin]

THANK YOU so much for the responses, acetone, Jessed and Alankay. I really appreciate it. I hadn't thought of the newer tricyclics, Alankay. Thank you for that helpful suggestion. Definitely something to ask my psychiatrist about. I think it probably is safe to say that I've come to the end of the road with SSRI's/SNRI's.

Wow, Jessed, your post really blew me away. Seriously. You are a gem. I can't thank you enough for sharing so much helpful info. I will definitely be printing your post out!! It's fascinating to hear all the different approaches you tried. That is definitely something I could explore further too. I did in fact go and see a naturopathic doctor here and I was really hopeful. But, while she did do some tests on me - food allergies etc - it turned out she was mainly into homeopathy and gave me a bunch of homeopathic tinctures. I went to see her for several months - at great expense - but I didn't really notice an improvement and I also don't totally buy into homeopathy. I would be willing to try again with someone else, but probably not go the homeopathic route.

I've read about Buteyko and that sounds really interesting. He advocates only ever breathing through your nose, even while exercising, and this is not something I'm always able to do because of sinus stuff. But I can imagine that - not to mention the sinus stuff - could also be effecting how I feel overall. My breath-holding time was rather poor (I can't remember the number now. I followed his online video) even though I consider myself pretty fit because I have always done regular cardio exercise throughout my life (running and hill walking) and still do that now. But when I'm not exercising I think my breathing is often times quite shallow.

Thanks so much for encouraging me to expand my tool chest. It makes me feel better just knowing there ARE other things I can try, rather than feeling hopeless about hitting a wall. THANK YOU!!!!!!

PS: Jessed, do you mind if I ask which atypical you were on?